Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 1041C0700X | Social Worker | Clinical | 103259 | MASSACHUSETTS | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1041394 | OTHER | | CIGNA BEHAVIORAL HEALTH |
| 2 | 286320 | OTHER | | PRIVATE HEALTHCARE SYS |
| 3 | 5681738 | OTHER | | AETNA BEHAVIORAL HEALTH |
| 4 | 757524 | OTHER | | TUFTS HEALTH CARE |
| 5 | 1932199569 | MEDICARE NSC | MASSACHUSETTS | |
| 6 | 063493000 | OTHER | | MAGELLAN BEHAVIORAL HEALT |
| 7 | 017882 | OTHER | | VALUEOPTIONS |
| 8 | 25576 | OTHER | MASSACHUSETTS | MBC HEALTHNET |
| 9 | 6253793 | OTHER | | UNITED BEHAVIORAL HEALTH |
| 10 | P01380 | OTHER | MASSACHUSETTS | BCBS MA |
| 11 | 1P086418 | OTHER | | HUMAN AFFAIRS INT'L |
| 12 | 3851-7 | OTHER | RHODE ISLAND | BCBS RI |
| 13 | 406307 | OTHER | RHODE ISLAND | BLUE CHIP BCBS RI |
| 14 | 1851331 | MEDICAID | MASSACHUSETTS | |
| 15 | PM35876 | MEDICAID | RHODE ISLAND | |
| 16 | 126506 | OTHER | | COMPSYCH |
| 17 | 095058 | OTHER | | MANAGED HEALTH NETWORK |
| 18 | 1891898 | OTHER | MASSACHUSETTS | MASS BEHAVIORAL HEALTH PA |
| 19 | S017173 | OTHER | | CHAMPUS |
